HomeMy WebLinkAboutWater Meter 14.034 o f PR.t CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT l- /3
..„.l 4INNBgoo 1. White File
2. Pink City 1
3 Yellow Applicant PERMIT NO. /5/..- 34_
(Please type or print and sign at bottom)
ADDRESS �_ ZONING (office use)
395 C�/ - 7�/ � i ice-- -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
Le) OWNER j m S jti/ 7X-O (Phone)
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ['Re-Roofing -DRe- Siding ❑Lower Level Finish ❑ Fireplace
El Addition ['Alteration ['Utility Connection i����
CODE: ❑I.R.C. ❑I.B.C.
Misc. l 'Z �« 1 1 & __1 E ""
Type of Construction: I II III IV V A B PROJECT COST /VALUE S
Occupancy Group: A 13 E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that •have fumis . info mation on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the ,
above - mentioned property and at a nsnuction ' .nform to all existing state and focal laws and will proceed in accordance with submitted plans. I am aware that the building
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official can revoke this perm • or j . caus in .•• . e, I hereby agree that the city official or a designee may enter upon the property to perform'necdcd inspections.
Signature �, —____, Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee 1 , C # $
Plan''Check Fee $ , ` 1 IMIll rater Meter Size 5/8 "; 1"; $
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State Surcharge $ \ 1`% ' V . ressure Reducer $
Penalty $ Connection Fee # $
Plumbing Permit Fee $ b \ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee TOTAL DUE $ 84-o . oo
This Application Becomes Your Building Permit When Approved Paid a 4 Re pt No. - 1-5 - e 7
Date f_ (3_14f-- -1-5-e By -
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372